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HomeMy WebLinkAbout038-1128-50-000 0 ~ I m o 3 0 H 0 m o N a o > I L o ~ I (6 N 'I L o ~ 3 I ~ °c I CD ry 'a a) U c I (r - i N N I a z 3 ti c a a) p N E Q 0w m M a I ct N I E ~ z II = ° I m 1M ~ a m o E zv' tn~~ a=i z° I ~ I M I III ~ I ~ !U ~ I N 0 z z O w z m = c I w E co N O d i p C) c d N O o N o a m a) U) Co F-N n in I E ° N p p 0 z •N : 12 a a a y 2 CD a E to J U U rn } `6 ° o N - O E N 0 C. N O ° a NI _ m N O U d Q } (D m ° m 7 I 00 N N 00 N c i O 0 3 6O - W o ) = E co O 5; U) 0 CD L? cl .6 ! V J E _ a W N m = N L N N M d ~ Y C O °O `n w o E R v I • co" c~ in (A C) Z N z r~' a dt Y E E E m v ~ I ~ 4k a m a IL 4-, E i' c R r A v a O U) U s W DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, P.O. BOX 7969 LABOR AND PERCOLATION -TESTS (115) MADISON, WI 53707 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/ Y: LOT NO.: BLK. NO.: SUBDIVISION NAME: SE 1,4N?d14 31 /T-)]- N/R1R-Z(or)W Star Prar.i_e n/a n/a n/a COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: St. Croix Larry Salmon 1854 Co. Rd. #C, Somerset, iii. 54025 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: (PROFILE DESCRIPTIO=RAA TESTS: ~esidence 3 n/a ❑New [teplace L 6-20-92 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: 5~;STEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) 0s ®U 12 S ❑ U El S ®U ❑ S ~ ❑ S 19U mound with variance If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: n/a Floodplain indicate Floodplain elevation: n/a d al' PROFILE DESCRIPTIONS page ]a AOA BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. GHES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 0-10,10yr7./2, L.; 10-17, 10yr4 1, s__. ; . - 7.5y r4/4 B 1 63 99.25 none 43 Is. & r-.;43-63,10vr5/1I,mot. si_I..(10yr6/3-7.5yr5/8 0-7,10yr,3 3,L.; -19 (yr. .,mot. fill,; B 2 66 °9.65 noon 7,5yr4/4, Is. &or.; 30-47, 7.5yr4/4, S. &gr.; 47-56- 99.75 -=~r_--t-1o_t s?_~ . yr _ -,yr B- 3 57 none 42 0-15 10 r2../7. L.• 15-24 10 r4/4, sil.; 24-42,- 7.5yr4/4,1.s.&gr.; 42-57,10yr5 , mot.si vr6 g_ 5 r5/8) 0-1-, l.Oyr2,/2,L.; 10-36,7.5yr1;/4,1s.&gr.; 36-50,- B 4 50 99.15 none 36 10 5 ~I mot.sil. lOvr6 3-7.5 r6 43 0-16,10yr3/3,L.; 16-2.4,10yr4/4,s_I.; 24-57,1_x.&9 g_ 5 60 99.75 none s - 60, 10yr5/3, m 1 mot. bands @43". 57 PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATER INCHES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD t PERIOD2 PERIOD P- P- P- P- P. PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe a the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings an c io ent of land slope. 10 SYSTEM ELEVATION 100.75 jJ I i 2~0 V+~ F. OJT ~ ~ i ,h~~+y IN , , A 5 A 0)0 i [ i.. Z I I , I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: Gary L. Steel ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optionall: 1554 200th. Ave.,New Richrtond, Wi. 54017 2298 715-2 i-6200 CST GN DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. l; Ilft-sl'r.; 6,1"') 1n,r,0r ST. CROIX COUNTY J r: WISCONSIN 011oltil ZONING OFFICE ST. CROIX COUNTY COURTHOUSE J, 911 FOURTH STREET • HUDSON, WI 54016 (15) 386-4680 ♦W July 14, 1992 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 To whom it may concern: An onsite investigation of the Larry Salmon property, located in the SE1/4 of the NW1/4, Sec.31, T31N-R18W, Town of Star Prarie, St. Croix County, has been conducted with the assistance of Gary Steel, CST #2298• This onsite revealed suitable soils north west of the existing dwelling to a depth of 36". This site is suitable for a replacement mound having 12 of sand fill or an at-grade system. i Should you have any questions, please feel free I tb contact this office. Sincer ly, ames K. Thompson Assistant Zoning Administrator cj AS BUILT SANITARY SYSTEM REPORT OWNER L A I 2 L MO A/ TOWNSHIP '3TA- R P RAh?,6;- SECTION---1_T-.3-~_N-R--LLW ' S J C ~ o rrUZ-VS,e,~ ADDRESS S 6T Y Q ST. CROIX COUNTY, WISCONSIN SUBDIVISION &A LOT LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM N i ~xxz9 9M I I 0000 0.f- EX, st sr►, aus~- V 0 8~ be ~ 8 PC V FoQcE7 /"IAlN 5 C~4G~ ~ .r r ~,0 i INDICATE NORTH ARROW rv P BENCHMARK: Elevation and description: NJ/) LOT ~SU1204 S%A Ck Alternate benchmark SEPTIC TANK: Manuf acturer : W LP ElC' S Liquid Cap. 1000 Rings used:7-Manhole cover jQ1,51 Final grade elev: /00.0 Tank inlet elev.:_93,57 Tank outlet elev.: 917S~ No. of feet from nearest road:Front , Side , Rear Ft. From nearest prop. line:Front , Side, RearaFt. No. of feet from: Well 7 5 t , Building: 12 1 (Inolude this information in the above plat plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE i PUMP CHAMBER Manufacturer: W498 CAS Liquid Capacity: ?406 Pump Model:_ L3 :-Z Pump/Siphon Manufact. :26,~-:rzicA_Pump Size, fR Elevation of inlet.-, , S Bottom of tank elevation Fri,3 Pump on elev.: Pump off elev.: =Gallons/cycle: Alarm: Man.:l_EUeL ALA&4 Switch Type: Location Distance from nearest prop. line. Front, Side, Rear_Ft. Distance from: Well 75- Building 3 Y SOIL ABSORPTION SYSTEM Bed: Trench: 6 14 Pit:_ fA Width:ength-YIE-Number of Lines:--aZ_Area Built Exist. Grade Elev.-/DO Proposed Final Grade Elev.-.1Q2.'-7 Fill depth to top of pipe: 5- No. feet from nearest prop. line:Front , Side, Rear_!j~Ft. No. feet from well:-7-!j~:_No. feet from building !5 y HOLDING TANK Manufacturer: Capacity: i No. of rings used: Elevation of bottom tank* Elevation of inlet: No. feet from nearest line:Front , Side , Rear Ft. No. feet f Well , building , nearest road arm Manufacturer: C~ INSPECTOR: DATE : - PLUMBER ON JOB LICENSE NUMBER: 3,205 6/90:cj I C Ig p • ST ARIE 31.31 P1~I~ATE N"XG SYSTE MI• C partmen o n us ry, KK County: Labor andHumanRelations INSPECTION REPORT .Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION 175631 Permit Holder's Name: ❑ City ❑ Village EkTown of: State Plan ID No.: SALMON LARRY STAR PRAIRIE ALP CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: a~~ 038-1128-50-000 A9200290 d _ TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.; Septic ; Benchmark Dosing Aeration Bldg. Sewer Holding St /jOt Inlet TANK SETBACK INFORMATION St/Outlet 9,3,3 Ventto TANK TO P/ L WELL BLDG. Ai Intake ROAD Dt Inlet /zi3 3 ' Septic v > O ' NA Dt Bottom > Dosing X02 7~v~ NA Uea&-r-/ Man. Aeration,— NA Dist. Pipe Holding Bot. System PUMP IXARWON INFORMATION Final Grade Manufacturer Demand ' -2 le-7 Model Number __ew ~?.%GPM TDH Lift///L' Friction System,-.6 TDH Ft Forcemain Length Dia. Dist-To Well H SOIL ABSORPTION SYSTEM BED/TRENCH Width q Length No. Of Trenches PIT Inside Dia. Liquid Depth DIMENSIONS / DI I N SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Man curer: SETBACK CHAMBER INFORMATION Type O k~ Model Num er. System: f'7" t, K~• > 7S AA OR UNIT DISTRIBUTION SYSTEM Wider-l Man~~old Distribution Pipe(s) , / x Hole Size x Hole Spacing Vent To Air Intake N Length 3~ Dia. Length Dia. Spacing -3~ / 9 3& SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over / I xx Depth Of xx Seeded/ Sodded xx Mulched Bed/ lmmigA Center Bed /Trench Edges 2 l 0 Topsoil ~j EjYes" ❑ No 0~y*s ❑ No COMMENTS: (Include code discrepancies, persons pr sent, etc.) 3 601 0q Li 1 - ~-1 Plan revision required? ❑ Yes 9_1No Use other side for additional information. SBD-6710(R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SANITARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than 1:1 1'7~ 8% x 11 inches in size. Check if ision to pr sous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. lc,:; 9c;z - PROPERTY OWNER PROPERTY LOCATION '/a IV 1/k, S T , N, R / E (orrqV PROPERTY OWNER' MAILIN ADDRESS LOT # BLOCK # ( ~ C Pt 6 C /V~4 CIA, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 11. TYPE OF BUILDING: (Check one) 11 State Owned VILLLLAGE : NEAREST ROAD a J C7 d C ❑ Public IN 1 or 2 Fam. Dwelling4 of bedrooms ~.-I A L A NU ) III. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 80 Mobile Home Park 12 ❑ Service station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. W Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 5_ 376 1133 ~O S Feet sz /Y Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank Lift Pump Tank/Si hon Chamber El. VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plu is Signature: (No ps M /M~SW No.: Business Phone Number: ITT _ f y : lumber's Address (Street, City, State, Zip Code)" IX. COUNTY/DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Is g Agent Sig o Stamps) Approved ❑ Owner Given Initial 7S A Surcharge Fee) Advers D terminati n X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS , 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at ftie time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 1 All revisions to thi,,- permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (S€?D 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to :3 years. 6. If you have questions concerning your onsite sewrage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. i To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. It. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill it the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for a// septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement- Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to :scale or with complete dimensions; location of holding tank(s), septic tank(s) or other treatment tanks, building sewers; .-.ells; water riairis water service; streams and lakes; purrs or siphon tanks; distribution boxes; soil absorr:tlon systems; replacement system areas; anO the location of `he building served; B) horizontal and vertical e==levation refcrefice points; C) complete specifications for pumps and controls; dose volume; elevation differences friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) :soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wiscrmn J n ;pct 410 included the creation of surcharges (fu s) for a numLr r regulated practices which can effect groundwater'. The monies collected through mircharges are used ;or rnonituring ground .,-Jer, 91w!rid- water coMamination investigations and establishment of standards. SBD-6398 (R.11/88) ST. CROIX EXCAVATING AN6. ail ROUTE 2 SOMERSET, WIS. 54025 PHONE 549-6651 MUM SYST E?',1 f or Larry Salmon SE 4Mt /4 S.31 T.31 R 18W Star Prairie Township St. Croix County Page 41 Plan approval application 42 St. Croix County Verification of Soils #3 Soil Data (115) #4 Plot Plan - Plan View #5 Work Sheet ,46 System Croxx Section 47 Pipe Lateral Layout #g Dosing Chamber #9 Pump Curve Donavin Schmitt 586 Valley View Trail Somerset, 'id. 54025 715-549-6651 "PRSW 3205 7-15-92 ~~4Gc~ ST. CROIX COUNTY WISCONSIN ``4 Iii )'r ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, W154016 . r: (715) 386-4680 July 14, 1992 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 To whom it may concern: An onsite investigation of the Larry Salmon property, located in the SE1/4 of the NW1/4, Sec.31, T31N-R18W, Town of Star Prarie, St. Croix County, has been conducted with the assistance of Gary Steel, CST #2298. This onsite revealed suitable soils north west of the existing dwelling to a depth of 36". This site is suitable for a replacement mound having 12 of sand fill or an at-grade system. Should you have any questions, please feel free to contact this office. Sincer ly, . J c ames K. Thompson / Assistant Zoning Administrator cj Wisconsin Department of industry. PRIVATE SEWAGE SYSTEMS Private Sewage Section tabor and Human Relations 2011. Washington Ave., Rm. 141 Safety and Buildings Division PLAN APPROVAL APPLICATION P.O. Box 7969, Madison, WI 53707 Bureau of-Building Water Systems (608) 266-3815 ' INSTRUCTIONS: Please fill in all applicable data and submit this form with plans. Plans will not be reviewed until all fees are received. The reverse side of this form describes most of the required plan information. Further requirements may be contained in the Wisconsin Plumbing Code, which can be purchased from the Department of Administration, Document Sales and Distribution, 202 South Thornton Ave., P.O. Box 7840, Madison: WI 53707, Telephone (608) 266-3358. 1 PROJECT INFORMATION (Type or print clearly) Plan Review Appointment Date Plan Identification Number . u 5eo 6 Name of Submitting Party (plans returned to same) Project Name Street Address, P.O. Box P or Rural Route Project Address or Legal Description UALI-EX EIV - &UIL131 7-31 Cit or Village State Zip Code City ❑ County Q,, S Village Q of Telephone No. (include area code) Town S T/} CILIX- Designer Name of Owner k/ F-A L 1-70A Telephone No. (include area code) Telephone No. (i clude area code) - 5'1' - 6,6 s / i. - o Street Address, P.O. Box I or Rural Route Street Address, P.O. Box * or Rural Route City or Villag State Zip Code City or Village State Zip Code l 2. APPLICATION FOR: ❑ Experiment Mound System ❑ Holding Tank ❑ New Construction ❑ Large System (over 8,000 gpd) Conventional System ❑ Groundwater Monitoring C, Replacement ❑ At-Grade ❑ System in Fill ❑ Petition For Variance ❑ Revision ❑ In-Ground Pressure ❑ System in Flood Plain (attach SBD-6698) ❑ Other 3. FEE COMPUTATIONS (include existing tanks) FEE SUBMITTED FOR OFFICE USE MAKE ALL CHECKS PAYABLE TO SAFETY 8 BUILDINGS DIVISION. a. 750- 1,500 gallon septic tank $110.00 /A9 b. 1,501- 2,500 gallon septictank $120.00 C. 2,501- 5.000 gallon septic tank $160.00 d. 5.001- 9,000 gallon septic tank $200.00 e. 9,001- 15,000 gallon septic tank S300.00 f- Over 15,000 gallon septic tank S500-00 g. 500- 1,000 gallon dose chamber S 70.00 7~. h. 1,001 - 2,000 gallon dose chamber S 80.00 i. 2,001- 4,000 gallon dose chamber S100.00 j. 4,001 - 8,000 gallon dose chamber S 120 00 k 8,001- 12,000 gallon dose chamber $140.00 1 Over 12,000 gallon Bose chamber S 160 00 cnr c ^,nr a!: h !d c fin n0 n 5.001 - ' C. ~Ou gallor ho!tling'.anK S 100 00 O Ove- 'e ga''on r 'I ng ~dnr S5,3 00 U Revre o^.s S 50 00 iority Rc ew Ec*e sam_ ar, •.m~asSubtc+.a - - Tota; Fee: Navwa"' Offs d^rC'.:? f•ii Shavvar. Office YJduA25hd Cf4,,e •5':~.. ,F . - - - - = wa _ :.~e ~(.c_:;~ -rEEi~Bdy$ifEE- c:( - _ rE•~ Rt 8.YBc.. 907_ Labusse.:K 5,+cC.3 r G bux 79o9 P O Bux 434 Wa„pEsha V:' :3188 Hayward. Wl 54843 Phone (608) 785-9334 Madison, W: 53707 Shawano, WI 54166 Phone (414) 548-8606 Phone (715) 634-4804 Fax (608) 785-9330 Phone (608) 267-51 19 Phone (715) 524-3626 Fax (414) 548.8614 Fax (715) 634-5150 Fax (608) 267-0592 Fax (715) 524-3633 SBD-6748 (R. 051.92) NOTE.Fees ate pursuant to Wis. Adm. Code, Chapter ILHR. 2, and OVER . are subject to change annua y. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND . PERCOLATION JESTS 115 P.O. BOX 7969 HUMAN FIELATIONS MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/N)tRN§MI{ITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: sr 1/44%71/ 31. /T31 N/111"4100 Star Prarie n/:1 n/a n/+f COUNTY: 0WNER7S-7B-U XRR, JLX*ME: ]MAILING ADDRESS: Croix Larry Salmon 1554 Co. Rd. SIC, Somerset, Wi. 54025 USE _ DATES OBSERVATIONS MADE NO. BEDRMS.: COMM~RC--TA- DPI 7 R'1 RO TC€T)E!;- FfiiOFJS: Z`oL fiTOfN T STS: 11{:~Residence n/a ❑New eplace I 6-24-92 ~ 6-26-92 RATING: S= Site suitable for system- U- Site unsuitable for system tlONVEr 1~FJ1R MOUND: IH-GROUN'l> R E: S M•IN-FiEL FOLDING TANK: RECOMMENDED SYSTEM:(optional) ❑S DUI aS ❑U [ ❑S UU ❑S ®U El S DU momid II Percolation Tests are NOT required DESIGN RATE: If any portion the tested area is in the /a under s.1-163.09115)11b), indicate: n/a n Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS page 19 AoA 6c)HING 1131TAL DEPTH TO R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH -NUMBER DEPTH IN, ELEVATION -OBSERVED ES". G EST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) - 77 B l 60 100.15 none 0-16, IN-0/3, I wr t i.I. . ; I-. - vr/i/<< 1.s. &gr. Plot. sLI. handS nL 43',97-60, 10yr- 5 mots yr1J3=~ 7MIFI--- B- 6, , • ; 10-313, . _ r I I B-2 50 99.95 none 36 36-50, 10yr5/4,mot. si_'.(l0yrf/3-7.5yr6/8 0-9, 10yr2/2, L.; q-17, -.5yr-. I, s . ; 1. 1.'- B- 3 12 ag,95 none 36 r3/4 Is. & pr. 36-52 10yr3/4not. si. (1.Oyr6/3 7.5yr4/6) 1- ?.0-43 B 55 100.15 none 43 0-11, 10vr3/3, L.; 11-20, 7.5yr3/4, s. ; . yr , Is. tgr.,; I~-55_,I yr mo 1 1. B- (10yr6/3-7.5yr4/6) PERCOLATION TESTS IEST DEPTH WATER IN IfoLE TEST TIME DROP IN WATER LEVEL-INCHES RAT E MINUf ES NUMBER INCHES AFTERSWEI_LING INTERVAL-MIN. PERIOD _t PERIOD2 _P_T1lr3D- PER INCH P_-1 24 _ _ none _ 30 2 - 2 -J P- 2. 7.4 none 30 2 j P- 3 21 none 30 P- 1'- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scaly, or distances. Describe what are the hori- 7onlal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION _ 1-01.15 p- I i ~v I. j i I tl~ I I T N i i , I I I I I 771 1 I, the undersigned, hereby certify that the soil tests reported on this form were made by me in-accord with the procedures and rop.thorls specified in the Wisconsin Achninistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge, and belief. NAME (print TESTS WE'RE cOMFLE IED ON: Crary L. Steel 6-26-02 HONE NUMBER (optional): ADDRESS: CERTIFIC I ION NUMBlj.~-24X200 1554 200th. AVe., New Ricluaond, wi. 54017 2~Px - CST ~NA : - DISTRIBUTION: Original and one col` local Authority, Property Owner and `;oil Tester. I i IIr1 ;f'r~ ri"?I't!i fI1. D2/R21 It pA G j5' y NOTE; ~T/fERE AREA n/o ' wELcS ui~T/i/N ,SDF7' OF SYSTEM. 1,A8hVOO/V 7&E 5S EpTic Sys7~/+~ /4 5 DE/r c.r/ R 83.03 C 2- ,3 ME AREA Asir l3Ecacv 7111 Dduwscoos eoar oATHE /'?ouAeo masT fcEl`lhi~y U~/~iSiuR/?rte. IVO ,L~4J_ 11.N l3 y °33 1 I It ~ C i Soo 0,00 r 3~ C 7 J s y S~E~ HOUSE l { ~ - 3soR. I t~'Q a f r u ITE SEW~O~ SYSY ~ SHEr~ ONS $O. LOT L /JV Sw - c ~ t~S) }-i1lR~Ar A`(1Oi1S LABOr 4 30 DEPArtTf4M1E 1~ 1S :311 u~ EV BM = /OOH D ToP /ylrp coT SuRuE Of{FtEVON N 5 TA SEE C S V s 77Rr~ C-c PRAU//ivO, FOIE ~ -8 -9~ DRAca/~ Uy. LARR SAC /-?ON , 195Y C7 'X PO C. SdCt v A y vice TrP. ~O~E/15~T W/'. Syo7.5' SeP7E/rSET. w~-,~yo3s' Of OPTIONAL WORKSHLET Page L MOUNU Sti S LLti1 L./5,/'~ 11. IN-Gk(It:'.U Fkt~',URF. SYSTEM-Continueo- ` I. WasteK'ate, l.ued, local Deily Flow= L`= gal. 10. 1 ortr Maw' ~('7]~/ Use s. T' I{R 83.15 (3) (c) mtmwum Uosina Rate = LRpm• Adm. (..id, and PROVIDE A DETAILED ")...Meter - _ _ in. LIS I OF ,ILING ON PLANS. I lo;,,i (irn.tmtL Head: 2. Depth to Lim1Ung Factor = L ft. ~Vs:cm Head = 2.5 ft. 3. Landslope = % Ve,t9cai Lift = ft. 4. Distance from Dose Chamber to Friction Loss = .21(012 - ft. Distribution System = ft. I DH = 17, ft. S. Elevation Difference Between 12. Pump Selection: Pump and Distribution System = 11~ ft. Pump will discharge at least Z on 6. Absorption Area Sizing: at /7i/.Z ft. total dynamic head. /~l and manufacturer: Area Required sq. ft. Pump m d Bed or Trench Length (B) _ ft. Bed or Trench Width (A) = ft. 13. Dose Volume: Trench Spacing (C) - ft. 10 Times Void Volume of f] 1L.Lf~ gal. 7. Mound Height. / Distribution Lines= Fill Depth (D) ft. Daily Wastewater Volume r cal. Fill Depth Downslope (E) ft. 4 Doses In 24 hrs. _ It 'T Bed or Trench Depth (F) _ 17s- ft. Backflow = gal. Cap and Topsoil Depth (G) = I ft. Minimum Dose = l.Z l.1 gal. Cap and Topsoil Depth (H) _ ~1 • S ft. 14. Dose Chamber: 8. Mound Length: Volume = ...LZ.S11L gal. End Slope (K) 0 ft. Total Mound Length (L) ft. 111. CONVENTIONAL PRIVATE SEWAGE SYSTEM 9. Mound Width: 1. Wastewater Load, Total Daily Flow /A UpslopeCorrection Factor= . 9y Use s. ILHR 83.15 (3) Upslope Width ■ ft. Adm. Code and PROVIDE DETDownslope Correction Factor LIST OF SIZING ON PLANS. Downslope Width (1) _ I ft. 2. Required Septic Tank Capacity = Total Mound Width (W) ft. 3. Percolation Rate = /in. 10. Basal Area: 4. Absorption Area Sizing: Infiltrative Capacity of Refer to Table 2 in Natural Soil = `v 1111- /day and PROVIDE A DETAI LIST OF Basal Area Required ==q. h. SIZING ON PLANS. sq. ft. Basal Area Available= 9y o sq. ft. Required Area = 11. If Standard Tables from Chapter II,HR 83 Length = ft. are used, Indicate Table # 7 Width = ft. 12. For the Distribution Network, Use Numbers 5.14 in Section III. Number renches = Trenclr'Spaeing = ft. 11. IN-GROUND PRESSURE SYSTEM S. Distritr(ition System: 1. Depth to Limiting Factor = ? ft. -Cateral Length = ft. 2. Landslope = % Number of Laterals = 3. Percolation Rate = °s -'7 min./in. Lateral Spacing = in. 4. Proposed System Elevation =0 ez, l s ft. Distance from Sidewall to Pipe : in. 5. Wastewater Load. Total Daily Flow: gal. System Elevation = ft. Use s. ILHR 83.15 (3)(c), Wis. Adm. Code and PROVIDE A DETAILED IV. SYSTEM-IN-FILL LIST OF SIZING ON-PLANS. Fill in All items from Section III Required Septic Tank Capacity = _.G slses~ gal. 6. Absorption Area Sizing: V. SEPTIC TANK_ gal ' Percolation Rate = min./in. 1. Capacity = MCC Area Required sq. ft. 2. Manufacturer: P• System Length ft. 3. Sho% Site Constructed Tank Details on Plan Sy>tem Width = ft. 7. Distribution Pipe Siting: VI. DOSING TANK Hole Siie = ~y in. I CAPACitl = l ~l 'E' Ex Cr .00 gal. Holc Spa.-inl: _ it. Al..nu(atturen L..lcr..l LenRlh It. Pump hlanul miurcr: Z'~ A;7L E2 I ..n•i.il Sin• ~ ~2 in. 1. I`umt• M.~JcI: / 37 - I ..1,i.91 \p.9.noe 3 It. Or:•jtmv. Hcid= Il..i.u.., 1u.n9 \ulrK.ill lu I'qN• m l• I R.il' - 2,Z, r7 gpm• H. Ih.u.ln.tum five 04..11.111;1- R.ile: Sh99K S,tv I: on%tru,tcd Tank Details on Plans Number ..1 I I.di-, 1*.•9 11119, 1 I..K I'.•. 1`qn• 1. g19i11. VII. 1101 I)INt• 1 \NA '1. M.91991"I'l \Ir9r9F l aC.i.~t1 = gal. 1 ei'pih - II ~K ; c'..n.lru.tcd Tank Detsilson Plans %IIOW At t. INFORM AT ION ON PLANS- 011 IIR \1111 0.161 (R it l'A:1 Page Of Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand H G 6" Topsoil F E D ONS11 SEW e -E A % slope Bed Of 2 %2 Force Main Plowed z f-= Aggregate Layer 't Below Pipe) DEPARTWIE~' ()F V iGS RELr17f1~ % Below Ft. ANN a3UC'Tr LA60S~ AN!D I DIP. c D ~JIS 0 OF E A_ Ft . ss Section Of A Mound System Using SEE GpRRE E A Bed For The Absorption Area F Ft. G Ft. Signed: - A 9_ Ft. H 1,5- Ft. B u;,7 Ft. License Number: 24zo6 K Ft. Date: 7- L Ft. J 9 Ft. I 1L Ft. W~ Ft. L 77 Observation Pipe B K A ( Force Main W I 0 "----T--------------- Distribution Bed Of 2~- 2 --7 Pipe Aggregate I Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area Perforated Pipe Detail /0 End View (Perforated i End Cap) i PVC P.pe oNe i Holes Located On Bottom, O`5 S Are Equally Spaced T Q ITS PGA gYSTE~ pNS nay, ra. vv P4ANl~f°r'r7 taN RttAT10NS A6DR ADD' ~t 1~~ JET ~ Y , ~ A gUl DI GS` Distribution - DEPARTMF~T ,'Jlot I Q~ AFCI Pip! Last Hole Should Be SEE C© Next To End Cop Distribution Pipe Layout P 3 Ft. FpRCL tfA/N • S 3' X 3 G Inches Y .3j;_ Inches Hole Diameter Inch Signed: Lateral Inch(es) License Number: p~ i!W 32 ` Manifold Inches Date: _ 7-6-9'2 Force Main Inches # of holes/pipe/4 Invert Elevation of LateralsiLL657t• FLJ P CHP.M.o ~R CRESS..`! C-IC'.: ~•.IJG PE CIF! - * I0"!` VEQ111T CAP `I' C. T. `LUT P!Pr _T WEATHERPROOF APPROVED LOCKINIG JUAICTION BOX -MAIJHOLE COVER 25' _ ~o.^~ Goa, w~u~A~tJV/Nb LAit~ WIMDOW OR FRESH 12 MIU. I AIR MTAKE GRADE I 4MIN. ( I B" hCl N. CO►JDUIT-- 18 ONSITE SEWAGEIRTr HT SEAL I I' ~ I III APPROVED JOINTS APPROVED JOINT A ~eLJ na .q I 11 1 W/C.I. PIPE III W/C.I. PIPE I I T EXTENDING 3' ALARM ONTO SOLID SOIL B I I I LAEaON ONTO SOLID SOIL ONTO SOLID SOIL I f~ELAT10N~ AND H ^ N I I ON ~A~EN J5 1 7Es5TR OF 'f . ASE 6U IN UEPAR. 11t1St0"1 ELEV. FT. PUMP SEE CORRE ~ OFF 0 COMCR£TE BLOCK RISER EXIT PERMITTED OiJLy IF TANK MAIJUFACTURER HAS SUCH APPROVAL SEPTIC E , SPEW FI'CATIOAIS oosE n TANKS MAWUFACTURER: Q~~~E~/I' G. NUMBER OF DOSES: PER DAM TAWK SIZE: 860 GALLONS DOSE VOLUME ALARM MAIJUFACTURER: / INCLUDING BACKFLOW: 111-2 GALLONS -f~ AL~Rr' MODEL IJUMBER: N,L'4 CAPACITIES: A12 IUCHES OR 392 GALLONS SWITCH TYPE: /~~,Fr"G/~? ' ^ g = x INCHES OR 32241 GALLONS PUMP MANUFACTURER: 226-1 2 C =INCHES OR 11371 2, GALLOWS MODEL NUMBER: 13-) D- 1-1_ INCHES OR 23 GALLONS SWITCH TYPE: ff U'd I/ MOTE: PUMP AND ALARM ARE TO BE INSTALLED ON SEPARATE CIRCUITS MINIMUM DISCHARGE RATE c c~ GPM VEKTICAL'DIFFEILE-MCE BETWEEAJ PUMP OFF AND DISTRMUTIOW PIPE.. FEET + MIAJIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . 2.5 FEET + 1J `O FEET OF FORCE MAIN X~FYo FT.FRICTIOLI FACTOR. FEET TOTAL DyIJAMIC HEAD FEET INTERNAL DIMF-WSIONC OF TANK: W4*r'-RA _0 ;WIDTH ;LIQUID DEPTH L_ 51GUED: A, A., t~~ \ LICENSF IJUMBER: 32o S DATE:_L_._°_s-2 3 F_ W HEAD/ ¢ W 115 CAPACITY 2 ills .105 95 CURVE 3° i 100 2 90 26 8 85 24 so MODEL EFFLUENT and W 75 MO 5EL 189 DEWATERING = 70 v 20 65- 18 60 0 55 16 50 MODEL 183 MODEL 1 F- 14 i 188 12 T~ ~~06 1 11 35 10 - - MODEL MODEL 8 30 137, 139 - 165 SEWAGE and 25 DEWATERING 6 +20 MODEL 161 15 MODEL 4 97 I I 10 W 2 MODEL H LL 5 53, 55, 57,59 0 GALLONS 10 20 30 40 50 60 70 80 90 100 110 24 75 LITERS 0 80 160 240 320 400 22 FLOW PER MINUTE 70 18 60_ MODEL 295 W 55 = 18 I i ~ I V 50 Q 14 45 MODEL 2 294 > O 12 J 35 MODEL Q F- 10 293 Q MODEL 30 i 281 Y ~ 8 MODEL 6 20- 282 to ~ OELLE/~' O. MODEL 2 267, 288 0 5 3280 Old Mlllm Lane GALLONS 10 20 30 40 50 60 70 80 90 100 110 120 '130 140 150 160 170 180 190 P.O. Box 16347 Loulaville, Kentucky 40216 LITERS 0 80 160 240 320 400 480 580 640 720 (502) 778-2731 FLOW PER MINUTE DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION AND PERCOLATION TESTS (115) MADISOP.O. BOX 7969 N WI 537 HUMAN 07 RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/f~~{ITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: SE I O/ 31 /T31 H/11434 (or) w Star Prarie n/a n/a n/a COUNTY: OWNER'S/BffX ME: MAILING ADDRESS: St. Croix Larry Sa]_mon 1854 Co. Rd. #C, Somerset, Wi. 54025 USE DATES OBSERVATIONS MADE CON TESTS: NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: R ATI Residence 3 n/a ❑Newleplace 6-24-92 6-26-92 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: rYSTE -1ILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ❑ S Cal HS ❑U ❑ S @7U E:] S CCU E] S HU mo+and DESIGN RATE: If Percolation Tests are NOT required I If any portion of the tested area is in the n/a under s.H63.09(5)(b), indicate: n/a Floodplain indicate Floodplain elevation: PROFILE DESCRIPTIONS page 19 AoA BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) - 0-16, 10yr3 3, L.; 16-24, 1 , Sill.; B-1 60 100.15 none 43 vr4/4 Is. &gr. mot. sil bands at 43',57-60, 10yr- 5 3, mot. sil. ,,r - B- r . 10-36, yr s. &gr.,; 1.(10yr6/3-7.5yr6/3 B_2 50 99.95 none 36 36-50, 10yr5/4,mot. si1 3 52 09.95 none 36 0-9, 10yr2/2., L.; 9-17, 7.5yr si--• ; 11-36, /.1- B- 9.95 3/4 ls. & r_. 36-52 10yr3/4mot. si. (10yr6/3- 7.5yr4./ 6) 2 3 [ ~_l • 20-43,- B-4 55 100.15 none 43 0-11 10vr3/ ,2 , L. 11-~. 0, 7.5yr. / s~ , 1; . yr , 1s. c gr. , ; a- , 10yrV4, mo . s1 B- (J_0yr6 / 3-7.5yr4 / 6 ) PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATER INCH ES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD t PERIOD2 P 21 P- 1 OD 3 24 none 30 2 2. P_ 2 24 none 30 2 20 P- 3 24 none 30 2 P-_ P- P- _ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 101.15 ~l 5 < I - 3 'ILA E E c TN , i E ~r 3 E Y € _ f e E i t l - - C~A I, the undersigned, hereby certify that the soil tests reported on this for a i m, ~ mC accord w procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the re+cg?~r~t~ tZest3 ny dge and belief. _ o2.a ti ~ NAME (print): n S R COMPLETED ON: Gary L. Steel 4..~M cc p ADDRESS: N C 12 ATION NUMBER: PHONE NUMBER(optional): 1554 200th. AVe., New Richmond, wi. 54017 to 29 24 200 Y,, NA E: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - INSTRUCTIONS FOR COMPLETING FORM 115 - SRD - 6396 To be a cornp'nd accurate soil test, your r t must include; 1. Complete . iption; 2. The use sec clearly indicate whether this is a residence or commercial 3. -AXIMUM n. of bedroom )r commercial use planned; 4, a new or -ient sy te the Sur rating ' A SITE PS SUITABLE FOR A HOLDING TANK ONLY IF ALL \ T -IER SYSTEM . , E RULED BUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. drawing to scale is preferred, A rate sheet. may t- used if desired; ;e re your ben hriark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all ar~j=r to boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if appropr i; 10. If the informati, r n as flood plain, elevation) does not apply, place N.A. in the approptiate box; 11. Sign the form at I place your current address and your certification number; 12= Make Iegihl and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 MAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL. TESTERS Soil Separates and Textures Other Symbols St - St:. (nver 10") BR - Bedrock cob - (3. 10"), SS - Sandstone gr - s :under 3") LS Lirnestone Y. HGW - Hig' t i dwater cs - C -1d Perc - r- :te riled s - r and W lh rl IS Fit ,sand Bldg _ Bui Is - Loamy Sand > Gr -an `sl - tidy Loam < - I 1 -o 3r, - 5! Lt7arn Bl - Si -unit Gy - Gr y ~cl - C'.iy Loam y _ 1 . love sc, - t<<, Clay L~ . R sic Clay L-_:., mot - SC y Clay A„Jr r S,c lay I p~ min rr H VJ L Six fi dis, r BM ' Vrip _ . ti - Point A TO THE OWNE first Ste! mil- C' It n, a=St e5t t=~ [F 3 r usl su' it ml t be outlined ar p, I SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER Lawrence P Salmon and Virginia L. Salmon, husband and wife. 1854 County Road C ADDRESS: Somerset, WI 54025 FIRE NO: 1854 Part of LOCATION: SE 1/4, NW 1/4, SEC. 31 T 31 N-R 18 W, TOWN OF: Star Prairie ST. CROIX COUNTY SUBDIVISION: N/A LOT NO. N/A Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system: St. Croix County residents may be eligible to receive a grant to help with the cost of the replacement of a failing system, which was in operation prior to July 1, 1978. St Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to the St. Croix County zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification from will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification form must be completed and returned to the St. Croix County Zoning Officer within 30 days of the hree year expiration date. SIGNED:a rence P. Salmon a SIGNED: it nia Salmon DATE: July 13, 1992 St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 APPLICATION FOR SANITARY PERMIT 3TC- 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor,(spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property Lawrence P. and Virginia L. Salmon, husband and wife Part o Location of property SE 1/9 NW 1/9, Section 31 , T 31 N_R 18 W Township Star Prairie Mailing address 1854 County Road C, Somerset, WI 54025 Address of site 1854 County Road C. Somerset, WI 54025 Subdivision name N/A Lot number Previous owner of property Harold P. and Virginia M. Salmon Total size of parcel Date parcel was created Are all corners and lot lines identifiable? x Yes No Is this property being developed for resale (spec house)? Yes x No Volume 854 and Page Number 379 as recorded with the Register of Deeds,. and additional parcel recorded in Volume 9,5f , page / q j INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful sous to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Nap shall also be required. PROPERTY OWNER CERTIFICATION 1(We) certify that all statements on this form are true to the best of my (our) knowledge; that J (we) am (are) the owner(s) of the property described in this information form, by virtue of a-warranty deed3reco ded in the Office of the County Register of Deeds as Document Nos. 452718 and•SOr.rR 2; and thatxl (We) presently own the proposed site for the sewage disposal system ~=xkx1asz)1xxhx" Rbki1ijmiixxsiNxxx xx x xmL-tWM W4iibWx4X&'b-dVWeVx w xxkmxxum X~x ff6e Rf.x:k yemxN-X, i tx fx x p xxxxxxxxxxxxxxxx) 84h ture of Owner Sign ure of Co-Owner (If Applicable) Lawrence P. Salmon Virginia L. Salmon -7111JU 7/13/92 Date of Signature Date of Signature DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2-1982 485829 V ~ 959 PA"11.49 REGISTER'S OFFICE Harold P. Salmon and Virginia M. Salmon, husband and ST. CROIX CO., W1 - . wif..e--- Reed for Record JUL 111992 conveys and warrants to -.Lawrence- P_.. Salmon and Virginia L....... Q~ 8:10 Am Sal Qn-,-"husband.-and"w f-P>llar. dal--survivorship------------- $1442 prpper.~y RETURN TO - - the following described real estate in St-..CerQiX .....................County, State of Wisconsin: Tax Parcel No: A11 that part of the Southeast Quarter of the Northwest Quarter (SE} of NWJ) of Section Thirty-one (31), Township Thirty-one (31) North, of Range Eighteen (18) West, Star Prairie Township, described as follows: Commencing at the Northeast corner of the Southeast Quarter of the Northwest Quarter (SEJ of NAT$) of saiO, Section Thirty-one (31); thence Westerly along the North line of said Southeast Quarter of Northwest Quarter Mi of NWT) for 236.5 feet; thence deflecting to the left 840 51' and on a bearing of South 70 09' West for 200.8 feet; thence South 20 00' West for 508.0 feet; thence South 50 49' West for 180.4 feet; thence South 230 02' West for 321.4 feet to the point of beginning of this description; thence South 880 00' East, 55 feet; thence North 230 02' East, 60 feet; thence North 880 00' West, 55 feet; thence South 230 02' West, 60 feet to the Point of Beginning. l L This parcel adjoins an existing parcel owned by the Grantees as recorded in Volume II "854", page 379 as Docent No. 452718. ii This is not homestead property. (is) (is not) Exception to warranties : I Dated this --------13th.------------ day of July... . . 1992..._. (SEAL) - .......(SEAL) i *Harold P. Salmon - -----------(SEAL) I .C.~t--~ . * * Virg ' is M. Salmon i ~I AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ss. St. Croix County. authenticated this ........day of 19...... Personally came before me this 13th._......day of July ' 1942- . the above named Harold P. Salmon and Virg inia M. Salmon TITLE: MEMBER STATE BAR OF WISCONSIN (If not- - authorized by § 706.06, Wis. State.) s to me kno he erson who executed the forego' s nt d acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Reinstra, Van Dyk & Needham, S.C. O1 South Knowles Avenue, $ox 127 .-...I--.:._.--! -RiolrmonE1, Gib 54417 Notary Pub' - St._-CrO1X----------------County, Wis. atures may be authenticated or acknowledged. Both My Commission is permanent. of necessary.) date: 19._.......) rsons signing in any capacity should be typed or printed below their signatures. nrrn crn rr nnn nF r• .•or,r Wisconsin LPCIal Blank Co.. Inr". '